Haematology

Question 1

Causes of splenomegaly

Answer 1

Congestive - cirrhosis, heart failure, thrombus (portal vein, hepatic vein, splenic veins)
Haematological malignancy - CML and myelofibrosis produce massive splenomegaly, lymphomas and other leukaemias can produce moderate splenomegaly
Haematologic other - haemolytic anaemias, spherocytosis
Infection - CMV, EBV, hepatitis, IE
Inflammatory - rheumatoid (Felty’s), sarcoid, SLE
Infiltrative - eg amyloid
Primary splenic disease (eg - splenic vein thrombosis)

Question 2

What are the main differentials for splenomegaly with and without lymphadenopathy?

Answer 2

Splenomegaly with lymphadenopathy - more likely to be a lymphoproliferative condition like CLL and lymphoma. Don’t usually get massive splenomegaly
Splenomegaly without lymphadenopathy - more likely to be a myeloproliferative condition like Myelofibrosis or CML. Can get massive splenomegaly. Can also be ET and PR

Question 3

What are the signs in chronic lymphocytic leukaemia?

Answer 3

Lymphadenopathy - especially cervical, supraclavicular and axillary
Splenomegaly
Hepatomegaly
Purpura
Skin changes - can manifest as macules, papules, plaques, nodules, ulcers, or blisters
Anaemia signs

Question 4

What is the characteristic feel of a lymph node?

Answer 4

Firm, rounded, discrete, non-tender, freely mobile

Question 5

How do you investigate for CLL?

Answer 5

FBC - elevated WCC with a lymphocytosis, anaemia, thrombocytopenia
Blood film - smudge cells
Flow cytometry

Question 6

When is treatment indicated for CLL?

Answer 6

“Active disease” - anaemia, thrombocytopenia, severe disease burden with painful lymphadenopathy, significant B symptoms

Question 7

What happens in primary myelofibrosis?

Answer 7

Characterised by abnormal production of red blood cells, white blood cells, and platelets, in association with marrow fibrosis (scarring) and extramedullary haematopoiesis

Question 8

Clinical features of myelofibrosis

Answer 8

Splenomegaly - can be massive
Hepatomegaly
Features of extramedullary haematopoiesis - haemorrhage, spinal cord compression, neurologic, ascites, pericardial/pleural effusion
Features of portal hypertension

Question 9

What is the normal liver span?

Answer 9

10cm in men, 7cm women